RIGHT TO FOOD IN INDIA

Transcription

1 Working Paper No. 50 August, 2003 RIGHT TO FOOD IN INDIA S. Mahendra Dev CENTRE FOR ECONOMIC AND SOCIAL STUDIES Begumpet, Hyderabad

2 RIGHT TO FOOD IN INDIA S. Mahendra Dev Abstract The objective of this paper is to examine right to food in the Indian context. We analyse the right to food in terms of availability, accessibility, adequacy and sustainability. These are examined in terms of equity and justiciability. The study is different from the earlier studies on food security as it is based on human rights approach. The issue of food is approached from the rights perspective. Specifically, the paper addresses the following questions: (a) What are the definitions, contents and obligations of right to food? (b) How far India progressed in fulfilling right to food? (c) What are the programmes and policies India followed in achieving right to food? (d) What should be done to achieve right to food to all citizens of India? Progress is examined in terms of availability, accessibility (physical and economic). policies and Programmes are scrutinized in terms of obligation to respect, protect and fulfill (facilitate and provide). India is signatory to many international treaties involving right to food. Indian Constitution also indirectly refers to right to food. Therefore, there is an obligation for the Indian Government (Centre and states) to fulfill the right to food of the people. In spite of many programmes, there are concerns regarding food and malnutrition. Some of the worst violations of the right to food can be seen in India today. We examined the problems of various welfare programmes. In order to realise right to provide, the following programmes have to be strengthened and implemented effectively. (a) Public Distribution system and Annapurna schemes; (b ) Extending Antyodaya Anna Yojana to all the destitutes in the country.; (c) Nutrition programmes for education (mid-day meal schemes) and Integrated child development schemes (ICDS); (d) Extending Maharashtra s Employment Guarantee Scheme (EGS) throughout India. Part of the wages can be paid as food; (e) Gender aspects of food security should be given importance in realizing right to food. Women s economic and social empowerment not only improves intra-household food distribution and health related matters but also improves the working of food and nutrition programmes. i

3 We also examined the market reforms needed for achieving higher and sustainable growth in agriculture and right to food for the poor. All the things have to be based on rights based framework of equality, non-discrimination, transparency, accountability and participation (ENTAP). Better monitoring systems have to be developed at Central, state, district and village levels to realize right to food. Justiciability is one aspect of right to food. In this context, recent Supreme Court Orders and the Right to Food to campaign are in the right direction. However, one (particularly the poor) cannot go to court every time right to food is violated. It is the responsibility of citizens and NGOs to organize campaigns for better functioning of the programmes. Also there is a need for better delivery systems by the government with transparency and public accountability. Other rights such as right to health and education, right to information etc are equally important to realize right to food. We have to focus more on demand side (social mobilization, accountability etc.) in the rights approach. Finally, the paper argues that right to employment is crucial for achieving right to food. This paper was written as part of the project on Right to Development in India of the Centre for Development and Human Rights (CDHR), New Delhi and FXB Centre for Health and Human Rights, Harvard School of Public Health, Boston, U.S.A. Earlier drafts of this paper have been presented and discussed at two workshops organized by CDHR at New Delhi in 2002 and 2003 and a seminar at Centre for Economic and Social Studies. Thanks are due to participants for their observations at these meetings. The author is grateful particularly to Arjun Sengupta, N.J.Kurian, Stephen Marks, Jean Dreze and Jos Mooij for their comments on the earlier drafts. ii

4 RIGHT TO FOOD IN INDIA S.Mahendra Dev 1. INTRODUCTION Right to food is part of an overall goal of achieving right to development. The adoption by the United Nations in 1986 of the Declaration on the Right to Development was the culmination of a long process of international deliberation on human rights which were perceived from the very beginning as an integrated whole of all civil, political, economic, social and cultural rights 1. The Declaration says The Right to Development is an inalienable human right by virtue of which every human person and all peoples are entitled to participate in and contribute to and enjoy economic, social, cultural, and political development in which all human rights and fundamental freedoms can be fully realized (Article 1, Paragraph 1). Because of its association with justice and equity, the Right to development is fundamentally different from conventional policies and progress for development, whether seen as increasing the growth of GNP, supplying basic needs, or improving the index of human development. The rights based approach imposes additional constraints on the development process, such as maintaining transparency, accountability, equity and non-discrimination in all the programmes. The individuals must have equal opportunity of access to the resources for development and receive fair distribution of the benefits of development. 1 See Sengupta (2000, 2000a, 2002), Marks (2000) and Franciscans International ( ). The right to development, as adopted by the Declaration and reaffirmed in the Vienna Declaration of 1993, reunified all these rights into an integrated and interdependent set of human rights, identified with a process of development. Osmani (2000) deals with a set of issues related to the human rights to food, health and education. He elucidates the philosophical underpinning of these rights, by using the conceptual framewok of capabilities developed by Amartya Sen. In this context, the notion of capability rights as goal rights is elaborated and contrasted with a popular version of libertarian rights. In this context see Sen (1982 and 1985). 1

5 Another important thing is that the right to development approach confers unequivocal obligation on duty-holders: individuals in the community, states at the national level, and states at the international level 2. Nation states have the responsibility to help realize the process of development through appropriate development policies. Although all rights are important, right to food plays a pivotal role in the rights based approach to development. The objective of this paper is to examine right to food in the Indian context. We analyse the right to food in terms of availability, accessibility, adequacy and sustainability. These will be examined in terms of equity and justiciability. The study is different from the earlier studies on food security because it is based on human rights approach. The issue of food is approached from the rights perspective. Specifically, the paper addresses the following questions: (a) What are the definitions, contents and obligations of right to food? (Section 2) (b) How far India progressed in fulfilling right to food? (Section 3) (c) What are the programmes and policies India followed in achieving right to food? (Section 4) (d) What should be done to achieve right to food to all citizens of India? (Section 5) 2. DEFINITION, CONTENTS AND OBLIGATIONS OF RIGHT TO FOOD In order to analyse right to food it is important to be clear about the definition, contents and obligations. This section covers these aspects Definition The evolution of the human right to food derives from the larger human right to an adequate standard of living given in the Universal Declaration of Human Rights (UDHR), Article 25 (1) of the UDHR asserts that everyone has the right to a standard of living adequate for the health and well-being of himself and his family including food, clothing, and housing... In several other international instruments, the right to food is recognized as part of the right to an adequate standard of living, focusing especially on the need for freedom from hunger. The Preamble to the Constitution of the Food and Agricultural Organisation (FAO) 1965, declared that ensuring humanity s freedom from hunger is one of its basic purposes. 2. See Sengupta (2000a) 2

6 The right to food, and the measures that must be taken, are laid out quite clearly in article 11 of the International Covenant on 3 Economic, social and cultural rights. Paragraph 1 calls on States to recognize the right of everyone to an adequate standard of living for himself and his family, including adequate food and the continuous improvement of living conditions. Paragraph 2 is more precise, as it demands that States guarantee the fundamental right of everyone to be free from hunger, and asks them to take individually and through international co-operation, the measures, including specific programmes, which are needed : (a) to improve methods of production, conservation and distribution of food by making full use of technical and scientific knowledge, by disseminating knowledge of the principles of nutrition and by developing or reforming agrarian systems in such a way as to achieve the most efficient development and utilization of natural resources; (b) taking into account the problems of both food-importing and food exporting countries, to ensure an equitable distribution of world food supplies in relation to need. The UN Convention on the Rights of the Child (CRC), 1989, goes beyond hunger and addresses the issue of child nutrition. Towards the late 1990s, work on the human right to adequate food at the global level centred on a mandate from the World Food Summit (WFS) held in Rome in The summit adopted a Plan of Action aimed at reducing the number of undernourished people to half their number by The Plan of Action contained seven commitments that were to act as guiding principles to all those involved in formulating the policies to implement the Plan at the national and international levels and spelt out objectives and actions for the implementation of these commitments. Objective 7.4 (under commitment 7) stipulates the need to clarify the content of the right to adequate food and the fundamental right of everyone to be free from hunger. It also called upon UN commissioner for Human Rights to better define the rights related to food in Article 11 of the Covenant and to propose ways to realize these rights The operational concept of right to food as used by FAO is that of food security which says food security exists when all people, at all times have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. 3. More on this see Ziegler (2002), Osmani (2000) 3

7 During the World Food Summit at Rome, the plenary of the parallel NGO forum proposed a Code of Conduct (CoC) on the Right to Adequate Food. The Code of Conduct (CoC) discusses the normative content of the Right to Adequate Food, the corresponding obligations of state and non-state actors, the role of civil society and the means and methods of implementation. Article 4 of the Normative Content states that The right to adequate food means that every man, woman, and child alone and in community with others must have physical and economic access at all times to adequate food or by using a resource base appropriate for its procurement in ways consistent with human dignity. Article 4 further states that the realization of the right to adequate food requires: (a) the availability of food, free from adverse substances and culturally acceptable, in a quantity and quality which will satisfy the nutritional and dietary needs of individuals; (b) the accessibility of such food in ways that do not interfere with the enjoyment of other human rights and that is sustainable. The CoC specified that the ultimate objective of the right to adequate food is the achievement of nutritional well being. It, therefore, states that the right to food needs to be understood in a much broader sense as the right to adequate food and nutrition. The CoC was recognized by the Office of the UN High Commissioner for Human Rights (OHCHR) and a series of expert consultations, conferences, studies steadily clarified the meaning of the human right to food. This finally culminated in the publication in May 1999 by the UN Committee on Economic, social and Cultural Rights of its General Comment 12 (GC12), considered to be the most authoritative interpretation of the right to adequate food. While reaffirming the definition of the CoC, it added the right to adequate food shall, therefore, not be interpreted in a narrow or restrictive sense which equates it with a minimum package of calories, proteins and other specific nutrients. The right to adequate food will have to be realized progressively The Content of Right to Food The General Comment 12 (GC12) says that the core content of the right to food is availability and accessibility. The availability also includes adequacy and acceptability Availability The notion of availability as set out in GC 12 is as follows: (a) Feeding oneself directly from the productive land or other natural resources 4

8 (b) a well-functioning processing and distribution system that can move food from the site of production to where it is needed in accordance with demand. According to Asjborn Eide, senior fellow of the Norwegian Institute of Human Rights, it is not enough for the foodstuffs to be physically available. They also have to satisfy the following criteria in order to qualify as adequate: (a) satisfy the dietary needs (energy and nutrients including the micronutrients like iron, vitamin and iodine); (b) be culturally acceptable (fit in with prevailing food or dietary culture); (c) be safe (free of toxic elements and contaminants); and (d) be of good quality (in terms of, for example taste and texture) Accessibility The notion of accessibility in GC12 incorporates both physical and economic accessibility Economic accessibility implies that the personal or household financial cost associated with the acquisition of food for an adequate diet should not be so high as to compromise on other basic needs. As the resources available to an individual or household are limited, an increase in the cost of acquisition of food for an adequate diet could lead to a cutting back on other items of essential expenditure. However, socially vulnerable groups such as landless persons and other impoverished segments of the population may need attention through special programmes to facilitate economic accessibility. Physical accessibility means that adequate food must be accessible to everyone. The sections of the population deserving special attention and priority consideration in this respect have been identified as the physically and mentally vulnerable which may include infants and young children, elderly people, the physically disabled, the terminally ill and people with persistent medical problems. The victims of natural disasters or people living in disaster-prone areas and other disadvantaged groups have also been identified as deserving special attention. The right to food also contains an element of sustainability. Adequate food must also be accessible in ways that are sustainable, that is, the long-term availability as well as accessibility of food must be ensured. 5

9 2.3. Obligations of the State The enjoyment of the right to food depends on several factors, ranging from access to land to sufficient income-earning opportunities. The Committee on Economic, Social and Cultural Rights (ICESCR) has entrusted national governments with the primary responsibility of ensuring the right to food. Under the right to food, there are three different levels of obligation the obligations to respect, protect and fulfill the right to food. The obligation to respect, as set out in Para 15 of General Comment 12, means that State parties should not take measure that would hinder the access to adequate food. In other words, States must not interfere with individual s livelihoods. Or, as Asjborn Eide explains, the States should, at the primary level, respect the resources owned by the individual and the individual s freedom to find: (a) a job of his or her preference, (b) make optimal use of his or her own knowledge (c) take necessary actions and use necessary resources (alone or in association with others) to satisfy her or his needs. The obligation to protect means that the state has to ensure that non-state actors (enterprises or individuals) do not deprive other individuals or group of their access to adequate food. So, rather than passively acknowledging the rights and freedoms of individuals, the state has to take due account of and action against any negative interference of a third party in the efforts of the individuals or groups to satisfy their needs. As Eide argues, the State at the secondary level is also obliged to provide active protection against other more assertive or aggressive subjects, in particular against more economic interests. These sections could be exercising fraud, displaying unethical behaviour in trade and contractual relations, or be involved in marketing and dumping of hazardous or dangerous products and unfair market practices, such as withholding price information or creating monopolies. The obligation to fulfill includes the obligation to facilitate and the obligation to provide. The obligation to facilitate means that the State must be proactive in strengthening people s access to food and utilization of resources and means to access to food. The obligation to provide means that States must fulfill the right directly whenever an individual or group is unable, for reasons beyond their control, to enjoy the right to 6

10 adequate food with the means at their disposal. Eide maintains that the facilitation may take the form of improving measures of production, conservation and distribution of food through complete utilization of technical and scientific knowledge and by developing or reforming the agrarian system. He has also identified the situations in which states must undertake direct provision of food or resources (through direct food aid or social security): (a) emergencies like severe drought or floods, armed conflict or the collapse of economic activities within a particular region of a country; (b) normal circumstances like unemployment on account of economic recession, old age infirmity, disability, marginalisation of a section of population (e.g. due to structural transformation in the economy and production). The core obligation in the case of the right to food relates to the State taking the necessary action to mitigate and alleviate hunger as provided for in Article 11 (2) of the ICESCR which recognizes the fundamental right of everyone to be free from hunger even in times of natural and other disasters. Violation of right to food General Comment No.12 also refers to violations of the right to food, which occur when the state fails to ensure the satisfaction of, at the very least, the minimum essential level required to be free from hunger. Moreover, if a State claims it is unable to fulfill its obligation for reasons beyond its control (e.g. resource constraints), it has to demonstrate to CESCR that it has done everything in its power to ensure access to food, including appealing for support from the international community. Violation of the right to food includes discrimination in the access to food as well to means and entitlements for its procurement on the grounds of race, colour, sex, language, age, religion, political or other opinion, national or social origin, property, birth or other status in a manner that impedes the exercise of economic, social and cultural rights. Implementing the right to food Since the means of implementing the right to food vary across nations, GC 12 requires State parties to develop a national strategy to ensure food and nutrition security for all, based on human rights principles. At the international level, States are required to recognize the essential role of international cooperation and to comply 7

11 with their commitment to take joint and separate action to achieve the full realization of the right to adequate food. 3. PROGRESS ON RIGHT TO FOOD As mentioned above, the content of right to food refers to availability, accessibility, adequacy and sustainability. We will examine the progress in the indicators relating to the contents of right to food in India. Availability, Accessibility and sustainability are not separate phenomena - they overlap. Food production is linked to livelihood access, food access and food consumption. Livelihood access in turn influences the demand for food and better prices and incentives for production. Better livelihood access also leads to better education, better living standards, better sanitation, and better knowledge of nutrition, better absorption and better health. For achieving accessibility it is also important that the poor have sufficient means to purchase food. The purchasing power of the poor to buy food can be ensured in two ways. One way is Government directly providing food or income support in the form of foodgains at subsidised prices, nutrition programmes, employment programmes. The other way is to increase purchasing power by facilitating creation of productive employment through sectoral development. Here right to employment or livelihood is important Availability 3.1.1Foodgrain production One achievement of India is that it achieved self sufficiency of food grains at the national level. After remaining a food deficit country for about two decades after independence, India has not only become self sufficient in foodgrains but now has a surplus of foodgrains (GOI, 2003). The situation improved gradually after the mid- 1960s with the introduction of high yielding varieties (HYVs) of crops, and the development of agriculture infrastructure for irrigation, input supply, storage and marketing. The era of all-round development on the agriculture front has been called the Green Revolution. The foodgrains production increased from about 50 million tonnes in to around 211 million tonnes in The production of oilseeds, cotton, sugarcane, fruits, vegetables and milk also increased appreciably. However, in spite of the spectacular achievements, various constraints and disturbing trends continue to hamper the requisite growth of the agricultural sector. During the 1990s ( to ), the growth of agriculture decelerated as compared to the 1980s ( to ). The growth rate of foodgrains production declined to 8

12 1.92% per annum from 3.54% per annum. The growth rate of productivity in foodgrains decelerated to 1.32% in the 1990s as compared to 3.3% in the 1980s. The overall growth rate of crop production declined from 3.72% to 2.29% and productivity from 2.99% to 1.21% per annum Per capita Availability The per capita net availability of foodgrains increased only about 10 per cent over the last 50 years (see Table 1). During the same period, per capita availability of pulses declined significantly. On the other hand, per capita availability of sugar and edible oils has increased over time. In the 1990s, per capita availability of foodgrains has not increased because of 60 million tonnes accumulation of foodgrains by the government and due to exports. Table 1. Net Availability of Cereals and Pulses Year Per capita net availability Edible oil Vanaspati Sugar per day (grams) (Kg.) (Kg.) (Nov.-Oct.) (Kg.) Cereals Pulses Total Foodgrains * 0.7* 5.0* , (P) * Pertains to the year (P) Provisional. Source: Economic Survey , Government of India. 9

13 Changes in Consumption Patterns and demand for non-cereal food In spite of increase in per capita real expenditures during the period to , the per capita cereal intake declined in both rural and urban areas. However, the fall in cereal consumption was offset by increase in the consumption of non-cereal food. It is now widely recognised that the food basket is more diversified and dramatic changes in food consumption patterns have taken place in India in the post-green revolution period. For example, at the all India level, cereal consumption declined from 15.3 kilograms per capita per month in to 12.7 kgs per capita per month in in rural areas 4. This is true for all classes (rich and poor). The cereal shares have seen a dramatic decline of more than 10 percentage points (between to ) in most regions in both rural and urban India. Similarly, the share of meat and milk products, and vegetables and fruits has increased over time. Table 2 shows the following trends. (a) Cereal consumption has declined for all the classes (b) Rice consumption has not declined for the bottom 30% (c) Wheat consumption has been stagnant for the bottom 30% (c) Coarse cereal consumption has declined for all the classes (d) Budget share of non-cereal food has increased for all classes; the consumption of non-cereal food increased in constant prices even for the bottom 30%. (e) Budget share of non-food has increased for all classes It may be noted that changes in consumption patterns may reflect substitution away from cereals to other food items as income rise. Deaton and Dreze (2002) with the help of data collected by National Nutrition Monitoring Bureau (NNMB) show the substitution from cereals towards other food items with rising per capita incomes. According to some projections, the household demand for foodgrains would increase from 155 mt. in 2000 to 240 mt. In 2020; for milk and milk products from 64 mt. to 166 mt. and fruits and vegetables from 48 mt. to 113 mt. (Radhakrishna, 2002). The per capita availability of fruits was 58 grams per day and 179 grams per day for vegetables. Table 2 provides per capita availability and deficit of milk, egg and meat. It shows the need for increase in availability of non-cereal food. In terms of per capita availability non-cereal food like fruits, vegetables, milk, meat and fish India has not achieved self sufficiency. 4. For more details on changing consumption patterns, see Rao, CHH (2000) 10

14 Table 2: Changes in Consumption Patterns: to Rice (Kg/month) Decile Group Lowest 30% Middle 40% Top 30% All Wheat (kg/month) Decile Group Lowest 30% Middle 40% Top 30% All Other Cereals (kg/month) Decile Group Lowest 30% Middle 40% Top 30% All Total Cereals (kg/month) Decile Group Lowest 30% Middle 40% Top 30% All Budget Share of Food Decile Group Lowest 30% Middle 40% Top 30% All Expenditure on Non-cereal food (Rs. 0.00) /month prices Decile Group Lowest 30% Middle 40% Top 30% All Source: NSS Consumer Expenditure Surveys 11

15 Table 2a: Per capita Availability and Deficit of Milk, Egg and Meat Food Items Per capita ICMR dietary Per capita deficit Availability guidelines for Indians Milk 216grams/day 300 milli litre/day 34 grams/day Egg 30 eggs/annum 180 eggs/annum 150 eggs/annum Meat 3.24 kg/annum kg/annum 7.71 kg/annum Source: GOI (2003) 3.2. Adequacy Once the foodstuffs are physically available, they have to satisfy the dietary needs (energy and nutrients including the micronutrients like iron, vitamin and iodine), among other criteria, to qualify as adequate. Thus nutritional aspects need to be duly taken into consideration in order to look at the adequacy aspect in the availability of food and not just physical availability. Nutrition There are two possible ways to assess the adequacy of food and nutrition and to detect the presence of inadequacy intake among individuals and population groups 5. These are: Nutritional Intake Assessment and Nutritional Status Assessment. Measures of nutritional intake estimate the amount of food a person is eating and can be used to assess the adequacy of the quantity of dietary energy (and protein) supply. In simple terms, one can categorize people as being well nourished or undernourished based on whether their intake of food matches their food energy needs or nutrient requirements. The nutritional status of an individual or a representative sample of individuals within a population can be assessed by measuring anthropometric, biochemical or physiological (functional) characteristics to determine whether the individual is wellnourished or under-nourished. Thus one has to go for an assessment of adequacy from both these angles to substantiate whether the food that is available in adequate quantity is also nutritionally adequate or not. 5. see Shetty (undated); Also see Dreze and Sen (1989) for a discussion on intake and outcomes on nutrition. 12

16 Nutritional Intake Assessment Calories and Protein The per capita calorie intake for rural population declined from 2364 kcal per day in to 2030 kcal per day in (Table 3). For the bottom 30% of the population, the calorie intake increased up to and declined in In the year , the calorie intake was 1626 kcal per day for the bottom 30% of population. This level is much below the norm of 2400 calories in rural areas. However, there is a controversy over the minimum calorie consumption per consumer unit per diem. Sukhatme (1982) and Minhas (1991) have questioned the sanctity of calorie norms widely used by nutritionists and consider them to be exaggerated. The NNMB data in shows that about 48 per cent of the households consumed more than adequate amount of both proteins and calories, while 20 per cent of households consumed inadequate amounts of both the nutrients. Table 3: Average Per Capita Calorie Intake (kcal/day): Rural Decile Group Lowest 30% Middle 40% Top 30% All Soucre: NSS Consumer Expenditure Surveys The NSS data shows that the average protein intake in rural India remained at 62 grams per consumer unit per day until 1983 but declined by 2 grams in There are some states where the average protein intake has been declining continuously since These are Assam, Himachal Pradesh, Punjab, Tamil Nadu and Uttar Pradesh. In Kerala, Orissa and West Bengal, protein intake has increased. On the whole at the average level protein energy malnutrition is not apparent in any of the states. This, however, does not rule out the possibility of protein energy malnutrition in the lower expenditure groups (MS Swaminathan Research Foundation, 2001). Micro nutrient deficiencies Goitre due to iodine deficiency, blindness due to Vitamin A deficiency, dry and wet beriberi and pellagra were the major public health problems in pre-independent India. 13

17 Sustained dietary changes resulted in the elimination of beriberi and pellagra. However, there has not been any decline in the prevalence of anemia due to iron and folic acid deficiency; the decline in Vitamin A deficiency and iodine deficiency disorders has been very slow. Diet surveys have shown that the intake of Vitamin A is significantly lower than the recommended dietary allowance in young children, dietary adolescent girls and pregnant women. In these vulnerable sub-groups multiple nutritional problems coexist including inadequate intake of energy as well as of micronutrients other than Vitamin A (GOI, 2003). Access to Drinking water While empirical evidence tends to suggest a positive association between the calorie intake and nutritional status, the responsiveness is likely to be affected by the factors relating to health and environment. For example, safe drinking water is important for proper absorption of food. Around 23 per cent of the households get water from tap sources in rural areas (Table 4). Another 49 per cent of households get water from tube well/hand pump. But, there are considerable regional disparities in the major source of drinking water. 14

18 Table 4. Households by Major Source of Drinking Water ( ) Rural (%) States/Uts Tap Tube Tanker Pucca Tank/ River/ Other Well/ Well Pond Canal Pump (Reserved) Andhra Pradesh Arunachal Pradesh Assam Bihar Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh West Bengal All India Source: Maternal and Child Health Care in India, NSS 52nd Round, July 1995 June 1996, Report No.445. Nutritional Status Assessment of Children and Women The National Nutritional Monitoring Bureau (NNMB) provides the nutritional status of rural households in seven sample states for three periods: , and (see Table 5). The children aged 1-5 years are classified into different nutritional grades based on weight for age. If those classified in moderate and severe malnutrition ranges are considered together, the percentage of children affected by malnutrition declined from 62.5 in to 56.2 in and further to 47.7 in It is clear that in spite of some improvements in nutritional status, nearly half of the rural children suffer from malnutrition 6. Among the sample states, Madhya Pradesh and Orissa are having the highest incidence of malnutrition. 6. Children of the poor communities suffering from malnutrition not only do not achieve full genetic 15

19 Table 5 Per cent Distribution of Children (Aged 1-5 Years) by Nutritional Grade in Rural Areas of Selected States State Period Normal Mild Moderate Severe Kerala Tamil Nadu Karnataka Andhra Pradesh Maharashtra Gujarat Madhya Pradesh Orissa All states* Notes: Based on National Centre for Health Statistics (NCHS), standards * Pooled estimates for Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, Maharashtra, Gujarat, Madhya Pradesh and Orissa. Source: National Nutritional Monitoring Bureau, Report of the Repeat Surveys Rural, 2001, National Institute of Nutrition, Hyderabad. Quoted in Radhakrishna (2002) National Family Health Surveys (NFHS I and NFHS II) provide information on undernourishment of women and children (Table 6). Comparison of Body Mass Index (BMI), which is essentially a measure of weight for height, brings this out clearly the undernourishment of women. At the all India level, 36 per cent of women were suffering from undernourishment in The malnutrition (weight for age) for children declined from 53.4 per cent in to 47 per cent in at all India level 16

20 (Table 6). But, the levels are still high. Inter-state disparities can be seen from Table 6. In Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh, the incidence of malnutrition was more than 50 per cent in Malnutrition of women is also high in these states as shown by the body mass index. Table 6 : Anthropometric Measures Women and Children (%) States/Uts Women BMI Children below 2 SD # <18.5Kg/m 2 Weight-for-age Height-for-age Weight-forheight Andhra Pradesh ## 38.6 ## 9.1 Arunachal Pradesh Assam Bihar Goa Gujarat Haryana Himachal Pradesh ## 41.3 ## 16.9 Jammu & Kashmir Karnataka Kerala Madhya Pradesh ## 51.0 ## 19.8 Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu ## 29.4 ## 19.9 Tripura Uttar Pradesh West Bengal ## 41.5 ## 13.6 All India Note: 1. Includes percentage of ever-married women with BMI below 18.5 kg./m 2.. Body Mass Index is the ratio of the weight in kilograms to the square of the height in meters (kg/m 2 ). The data exclude women who are Pregnant and women who gave birth in the preceding two months. 2. The index for children is expressed in standard deviation units (SD) from the median of the International Reference Population Figures are for children born 1-47 months prior to survey. 3. #: includes children who are below-3 SD from the International Reference Population. 4. ##: Not available as children s height not measured figure for Jammu & Kashmir covers only the Jammu region. Source: National Family Health Survey (NFHS-1 & 2), , October, 2000, Table 7.5, page 246 and Table 7.17, page 270. For Table page 286. Some indicators on anemia of women and children based on NFHS data are given in 17

21 Table 7. It shows that more than 50 per cent of women and more than 70 per cent of children have anemia. Considerable regional disparities can be noticed in these indicators. Table 7. Percentage of Women and Children with Anemia : States Percentage of Women Percentage of children with any anemia with anaemia Andhra Pradesh Assam Bihar Gujarat Haryana Karnataka Kerala Madhya Pradesh Maharashtra Orissa Punjab Rajasthan Tamil Nadu Uttar Pradesh West Bengal India Source: National Family Health Survey (NFHS-2), Accessibility Physical accessibility Availability or physical access of foodgrains at the national level is not a problem. However, it is a problem for North Eastern states and other remote and tribal areas. Also, it is a problem for vulnerable groups such as old age population, pregnant and lactating women, children, tribals etc. As shown below, Government has programmes to take care of the problems of physical access in remote areas and vulnerable groups. Intra-household Distribution of Food consumption One important dimension of physical accessibility is intra-household disparity in consumption. It is widely believed that in India, particularly among the rural poor, 18

22 food distribution is not based on need. The breadwinner gets sufficient food, the children get the next share and the women take the remains. In times of scarcity, the dietary intake of women and children are likely to be most adversely affected. Among children, boys are given preference to girls in distribution of food. Several micro studies in different states have reported that intra-household distribution of food follows this traditional pattern even today. However, the empirical evidence shows that the intra-household discrimination is found in some areas only. Haddad et al (1996) provide a review of the literature on intrahousehold bias for different countries. Food allocation is the most studied dimension of intra-household inequality. In general, the adjustment for body weight and activity tends to support gender neutrality of intra-household, although a slight pro-male bias persists. Boys may be favoured in India by being given first priority in breast-feeding and in food supplementation (Pettigrew 1986). In India, upper-middle caste groups favour sons more in food allocation than lower status groups and tribal groups (Warrier 1992). Miller (1981) found pro-male bias in North India while there was no sex preference in South India. Using village level studies of ICRISAT Behrman and Deolalikar (1990) do not find any evidence of gender discrimination in food intake. An analysis of household expenditures on goods consumed exclusively by adults (an adult good ) has been used as a parsimonious technique for examining discrimination within households. The basic idea is, do parents reduce expenditures on these adult goods more severely for an extra girl than for an extra boy? Subramanian and Deaton (1990) employ a representative sample of some 11,000 households from the state of Maharashtra, collected in They find some evidence of discrimination against girls under five years of age who live in rural households, but only in one (tobacco and paan) of the two identified adult goods (the other being alcohol). Another way is to look at the outcomes (nutritional status ) based on anthropometric measures. Sen and Sengupta (1983) studied the question of undernourishment of boys and girls in two villages of West Bengal. Based on weight-for-age indicator, they found bias to boys over girls. Sen (2001) cautions about the interpretation of causal process. The lower level of nourishment of girls may not relate directly to their being underfed vis-à-vis boys. Often enough, the differences may particularly arise from the neglect of health care of girls compared with what boys get (Sen, 2001). 19

23 While comparisons of percentages of underweight girls and boys (1-5 years old) at the all India level show insignificant differences in the rates of malnutrition (i.e. ratio close to 1), disaggregated state level data from recent studies by Department of Women and Child Development (1995/96) and the NNMB (1994) show a distinct trend of higher percentage of girls than boys who are severely underweight. Notably, while Tamil Nadu, Mizoram and Manipur record some of the lowest rates of severely malnourished children, a disproportionate share of them are girl children. Their ratios are 1.91, 1.58 and 2.10 respectively (World Bank, 2001). It may be noted that these gender discrepancies are likely higher to be if child mortality rates are accounted for. The National Family Health Survey 1992/93 of 25 states found that girl child mortality (ages 1-4) is 43 per cent higher than boys. Post-neonatal mortality of girls is 13 per cent higher than boys. If these girls had been alive, they would almost certainly have added to the prevalence of female malnutrition Economic Accessibility Hunger India has made significant progress in reducing the problem of hunger. Estimates of hunger (two square meals a day) based on self perception from NSS data show that less than 10 per cent of people suffer from hunger. However, in poorer states like Bihar and Orissa the per cent of people suffering from hunger is much higher. One of the major achievements of India in terms of food is that it averted famines since independence 8. The last one was the Bengal Famine of But, chronic poverty is still high in the country. This is because lack of economic access (purchasing power) to food. Poverty Ratios The expenditure on food (calorie intake) with some allowance for non-food expenditure is mostly used as a basis for determining the poverty line. Thus, the incidence of poverty in a region may give some indication of the extent to which food is accessible to households. India is perhaps the only developing country, which has the longest time series of national household surveys starting from the early 1950s. Till , National Sample Survey (NSS) data were available annually. Between and 7. By contrast, there are a few states (Karnataka 0.87, Gujarat 0.77, Goa 0.66 and Daman and Diu 0.70) where boys appear to be fairing worse than girls. In some states where studies of urban areas were conducted, a similar trend prevails. 8. More on this see Dreze and Sen (1989) 20

24 , six quinquennial surveys have been carried out with a large sample size of ten households per sample village. The official poverty ratios for all India and major states are given in Table 8. It shows that the rural poverty declined by about 10 percentage points in the 1990s while urban poverty declined by 9 percentage points during the same period. In almost all the states, poverty declined in the 1990s. However, rural poverty was above 40 per cent in three states viz., Orissa, Bihar, Assam and in three states (M.P., U.P, and West Bengal) it was above 30 per cent. In the case of urban poverty, states such as Orissa, M.P., Bihar, U.P. showed higher incidence in Thus, although income poverty declined significantly at the all India level, regional disparities are quite high. Table 8 Incidence of Poverty Across States States Rural Urban Total A.P Assam Bihar Guj Har Karn Ker M.P Mah Orissa Punj Raj T.N U.P W.B India Source: Economic Survey , Government of India Alternative Estimates of Poverty: The official estimates of poverty are based on the Lakdawala Committee s methodology. If one notices the numbers in table 8, the urban poverty was higher than rural poverty in 9 states. This is unusual. Deaton and Dreze(2002) estimated alternative poverty ratios based on the unit prices generated from NSS data. They have also adjusted for the non-comparability of NSS data. The alternative poverty estimates are given in Table 9. It shows that the rural 21

25 poverty was lower by around 2 percentage points while urban poverty for all India was considerably lower in the alternative estimates as compared to official estimates. It also shows that in all the states, urban poverty was lower than rural poverty. Table 9 Alternative Estimates on Incidence of Poverty: States Rural Urban Official Alternativ Official Alternativ Andhra Pradesh Assam Bihar Gujarat Haryana Karnataka Kerala Madhya Pradesh Maharashtra Orissa Punjab Rajasthan Tamil Nadu Uttar Pradesh West Bengal India Source: Economic Survey and Deaton and Dreze (2002) Based on growth in average per capita consumer expenditure (APCE) during to , Deaton and Dreze (2002) show a striking regional pattern : except for Jammu and Kashmir, the low growth states from one contiguous region made up of the eastern states (Assam, Orissa and West Bengal), the so-called BIMARU states (Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh) and Andhra Pradesh. The high growth states, for their part, consist of the southern states (except Andhra Pradesh), the western states (Gujarat and Maharashtra) and the North western region (Punjab, Haryana and Himachal Pradesh). Further, it is interesting to note that this pattern is reasonably consistent with independent data on growth rates of per capita state domestic product (SDP). 22